Provider Demographics
NPI:1336662451
Name:BENN, THOMAS JEFFREY (LMSW-CC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEFFREY
Last Name:BENN
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 DEVINE ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04353
Mailing Address - Country:US
Mailing Address - Phone:207-557-5513
Mailing Address - Fax:207-549-7186
Practice Address - Street 1:276 WHITTEN ROAD
Practice Address - Street 2:SUITE # 2
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347
Practice Address - Country:US
Practice Address - Phone:207-624-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC167261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical